Guardians Annual Report {17.7}

PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STORMER, JUDGE GUARDIANSHIP OF CASE NO. GUARDIAN'S ANNUAL REPORT [R.C. 2111.49] 1. Ward's present address: City: Zip: 2. Ward's living arrangements are: State: Telephone: His or her own apartment or home The guardian's home Facility Home (Group home, foster home or assisted living) Name of facility: Contact person at facility: Telephone of contact person: Other If other, the ward is living with whom? Relationship to ward: 3. Ward has been at the current residence since: 4. If the ward`s living arrangements have changed in the past year, please explain: 5. As guardian are you satisfied with the ward's care? If no, please explain: YES NO FORM 17.7 ­ GUARDIAN'S ANNUAL REPORT (Page 1 of 3) Rev. 07/13/2015 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. 6. List agencies/providers involved with the ward's care: Agency Contact Person Address Telephone 7. The ward's primary care physician: Address: Telephone: During the period covered by this report, the ward ward has been seen, the last date was: has has not been seen by a physician. If the and for the purpose of: 8. Have you observed any major change in the ward's physical or mental condition during the period covered by this report? YES NO If "yes" is checked, briefly describe the changes: 9. The ward's overall health is: excellent good YES fair poor 10. Is there a pre-need funeral established for the ward? If yes, name of funeral home: 11. How often do you personally visit your ward? NO Daily Weekly Monthly Annually Never Other: 12. The date of your last personal visit with your ward was: 13. Do you contact your ward in other ways? Telephone Mail Social worker or staff Other: Please specify how often these other contacts occur: 14. Are you able to continue to serve as guardian? If no, please explain: YES NO FORM 17.7 ­ GUARDIAN'S ANNUAL REPORT (Page 2 of 3) American LegalNet, Inc. www.FormsWorkFlow.com Rev. 07/13/2015 CASE NO. 15. I believe the continuation of the guardianship is necessary. Yes, continued No, not continued If not continued is checked, please provide the reasons: 16. Any additional information that you would like to provide: I hereby state that the answers set forth above are true and correct to the best of my knowledge and belief, and I am giving the answers subject to the penalties of making a false declaration. (Knowingly giving false information on a probate document is a criminal offense-O.R.C. 2921.13 (A)(11)) Attorney for Guardian's Signature Date Attorney for Guardian's Typed or Printed Name Address City State Zip Telephone Number (include area code) Attorney Registration No. Guardian's Signature Date Guardians Typed or Printed Name Address City State Zip Telephone Number (include area code) Guardian's Email Address (if available) FORM 17.7 ­ GUARDIAN'S ANNUAL REPORT (Page 3 of 3) Rev. 07/13/2015 American LegalNet, Inc. www.FormsWorkFlow.com PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STORMER, JUDGE GUARDIANSHIP OF CASE NO. ANNUAL PLAN FOR GUARDIANSHIP 1. Do you plan to change the Primary Care Physician listed on the Guardian's Report? YES NO If yes, please list the reason why: New Physician Name: Address: Telephone Number: 2. Is there a plan to change or add agencies/providers listed on the Guardian's Report involved with the ward's care? YES NO If yes, please list the reason why: Please provide the contact information of any new agencies: 3. Is there a plan to change the ward's placement? YES NO If yes, why the change? When will the change occur? Placement Facility Name and location: FORM 17.8 ­ ANNUAL PLAN FOR GUARDIANSHIP (Page 1 of 2) Rev. 07/13/2015 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. 4. Please describe the ward's participation in the following activities: Social/Recreational: Employment: Other: If the ward is not involved in activities please explain why: 5. Please describe how the ward's financial needs will be met in the coming year: Guardian's Signature Date Guardians Typed or Printed Name Telephone Number (include area code) Guardian's Address City State Zip Guardian's Email Address (if available) FORM 17.8 ­ ANNUAL PLAN FOR GUARDIANSHIP (Page 2 of 2) Rev. 07/13/2015 American LegalNet, Inc. www.FormsWorkFlow.com